Individual
MS. LEA HAYLEY BRAINERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4646 POPLAR AVE STE 409, MEMPHIS, TN 38117-4434
(901) 582-7243
Mailing address
1 DR ML KING JR AVE APT 231, MEMPHIS, TN 38103-1757
(901) 612-1486
(901) 425-9853
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
UC-51980AFD-1B01-483
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
Primary
4706
TN
363A00000X
Physician Assistant
PA00599
MS
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
4706
TN
363AM0700X
Medical Physician Assistant
PA00599
MS
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1188566
NCCPA CERTIFICATION
TN
01
—
4706
STATE LICENSE
TN
01
—
PA00599
STATE LICENSE
MS
Enumeration date
08/04/2021
Last updated
04/06/2023
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